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Year 3 - Clinical > 13 - STI > Flashcards

13 - STI Flashcards

1
Q

What are the common STI presentations?

A
  • Asymptomatic
  • Urethritis
  • Cervicitis
  • Genital ulcer disease
  • Prostatitis
  • Pelvic inflammatory disease (PID)
  • Vaginal discharge
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2
Q

What are the most common STIs?

A

Gonorrhea, chlamydia, and syphilis

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3
Q

What are some common co-infections?

A
  • Gonorrhea w/ chlamydia

- Syphilis w/ HIV (especially in MSM)

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4
Q

What are some risk factors for STIs?

A
  • Unaware/ lack of knowledge (from either pt or Dr.)
  • Gender (female > male generally)
  • Unprotected or anonymous sex
  • Sexual contact w/ infected person
  • # of sexual partners
  • MSM
  • Age, socioeconomic, societal stigma
  • Co-infection
  • Asymptomatic or missed sx
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5
Q

What is included in a clinical work-up for STIs?

A
  • Presentation, history, travel, contacts
  • Lab tests including HIV test (if pt consents)
  • Public health notification and contact tracing
  • Tx, follow-up, and counselling
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6
Q

What are some complications of STIs?

A
  • Pelvic inflammatory disease (1/3 attributed to gonorrhea and/or chlamydia)
  • Risk of cervical cancer
  • Damage to reproductive tract
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7
Q

What are the common age groups for the most common STIs?

A
  • Chlamydia and gonorrhea = females 15-24; males 20-29

- Syphilis = females 25-39; males 20-24 and 30-39

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8
Q

Do females or males have higher rates of infection for gonorrhea, chlamydia, and syphilis?

A
  • Gonorrhea and chlamydia = females

- Syphilis = males

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9
Q

What is some pt education that you can provide about STIs?

A
  • Risk of re-infection and of untreated infection
  • Abstain from sex at least 3 days after tx completed
  • Barrier protection for at least 7 days; recommend as much as possible
  • Reduce risks of sexual activity
  • Return to care if sx not improved
  • Testing
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10
Q

What causes gonorrhea?

A
  • Neisseria gonorrhoeae (gram neg diplococci)

- Exclusive human pathogen

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11
Q

What are the most common sites of infection of gonorrhea and some other possible sites?

A
  • Most common = urethritis, cervicitis

- Other = oropharynx, disseminated gonococcal infection (DGI), neonatal conjunctivitis

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12
Q

Common sx of gonorrhea

A
  • Purulent urethral or rectal discharge

- Abnormal vaginal discharge or uterine bleeding

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13
Q

What is disseminated gonorrhea infection? Symptoms?

A
  • When N. gonorrhoeae bacteremia seeds at sites outside of reproductive tract
  • Sx = fever, chills, joint pain/ swelling, skin rash
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14
Q

What should be considered for pregnant women w/ gonorrhea?

A
  • Choice of medication
  • Risk of transmission
  • Neonatal prophylaxis
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15
Q

How is gonorrhea diagnosed?

A
  • Sx and history

- Lab (gram stain; urine, cervix, or urethra culture; NAAT)

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16
Q

What are some tx issues w/ gonorrhea?

A
  • Emergence of antibiotic resistance
  • Increased tx failure and concern w/ superbug
  • Loss of penicillin, ampicillin, and FQs
  • Treat px for both gonorrhea and chlamydia
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17
Q

What is the tx for uncomplicated anogenital or pharyngeal gonorrhea infection in adults and youth >/ 9 y/o?

A
  • Ceftriaxone 250 mg IM [Cefixime 800 mg PO] x 1 dose + azithro 1 g PO x 1 dose
  • [Azithro 2 g PO x 1 dose]
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18
Q

What is the tx for uncomplicated gonorrhea in children < 9 y/o? What is the difference for anogenital or pharyngeal infection?

A
  • Cefixime 8 mg/kg (max 400 mg) PO BID x 2 doses + azithro 20 mg/kg (max 1 g) PO x 1 dose **preferred for anogenital
  • Ceftriaxone 50 mg/kg (max 250 mg) IM x 1 dose + azithro **preferred for pharyngeal
  • Ceftriaxone 25-50 mg/kg (max 125 mg/dose) recommended for neonates
19
Q

What is the tx for disseminated arthritis gonococcal infection in px > 1 m/o?

A
  • Ceftriaxone IV/IM daily x 7 days + azithro PO x 1 dose
  • Ceftriaxone = 2 g for 9 years and older; 50 mg/kg (max 1 g) for 1 month - 9 y/o
  • Azithro = 1 g for 9 years and older; 20 mg/kg (max 1 g) for 1 month - 9 y/o
20
Q

How do the treatment of disseminated gonococcal infection change for meningitis, endocarditis, or opthalmia?

A
  • Meningitis = duration 10-14 days and hospitalization indicated
  • Endocarditis = duration 28 days
  • Ophthalmia = 1 dose of each ceftriaxone and azithro
21
Q

What is the tx for anogenital gonorrhea w/ cephalosporin-resistance or anaphylaxis to penicillin or cephalosporin?

A
  • Azithro 2 g x 1 dose + gentamicin 240 mg

- Gent can be given IM as 2 separate injections or IV infused over 30 mins

22
Q

What is the tx for anogenital gonorrhea w/ macrolide-resistance or anaphylaxis to macrolides or cephalosporin?

A
  • Gentamicin 240 mg + doxycyline 100 mg x 7 days

- Gent can be given IM as 2 separate injection or IV infused over 30 mins

23
Q

When should follow-up occur for gonorrhea infections?

A
  • All pharyngeal infections
  • Case treated w/ regimen other than preferred regimen
  • Documented antimicrobial resistance
  • Infection during pregnancy
  • Children
24
Q

What are sx of PID?

A
  • Endometriosis, salpingitis (inflammation of fallopian tubes) and pelvic peritonitis
  • Lower abdominal/mild pelvic pain
  • Increased vaginal discharge
  • Irregular menstrual bleeding
  • Painful & frequent urination
  • Abdominal, pelvic organ, uterine tenderness
25
Q

Complications of PID

A
  • Tubo-ovarian abscess
  • Infertility
  • Ectopic pregnancy
  • Chronic pelvic pain
26
Q

Diagnosis of PID

A

Combination of signs & sx & gonorrhea/chlamydia positive

27
Q

Outpatient tx for PID

A
  • Ceftriaxone 250 mg IM x 1 dose + doxy 100 mg PO x 14 days +/- metro 500 mg PO BID x 14 days
  • [Azithro 250 mg PO daily x 1 week]
28
Q

Cause of chlamydia

A

Chlamydia trachomatis (gram neg, obligate intracellular pathogen)

29
Q

Sx of chlamydia

A
  • Men = mild dysuria, discharge, rectal pain/discharge/bleeding
  • Women = dysuria/frequency uncommon, abnormal vaginal discharge or uterine bleeding
30
Q

Special considerations for pregnant women w/ chlamydia

A
  • Should receive chlamydia test at 1st prenatal visit

- Test for other STIs if chlamydia positive

31
Q

Special considerations for newborns w/ chlamydia

A
  • 2/3 acquire infection from mother via endocervical exposure
  • Can cause neonatal conjunctivitis or pneumonia
32
Q

Diagnosis of chlamydia

A
  • Sx & history
  • Lab – NAAT (urine, eye, cervical); DFA/direct fluorescent antigen (throat, rectal, nasopharyngeal, pulmonary, eye); culture if tx failure
33
Q

Tx for uncomplicated anogenital chlamydia infection?

A
  • Azithro 1 g PO x 1 dose (for 1 m/o - 9 y/o dose is 12-15 mg/kg max 1 g)
  • [Doxy 100 mg BID x 7 days] only for > 9 y/o
34
Q

Tx for pregnant women w/ urethral, endocervical, or rectal chlamydia infection?

A
  • Erythro 500 mg PO QID x 7 days

- [Amox 500 mg PO TID x 7 days]

35
Q

Cause of syphilis

A
  • Treponema pallidum

- Exclusively human disease; invades through mucous membranes or open lesions

36
Q

Describe the stages of syphilis infection. Why is it important to know the stage the pt is in?

A
  • Primary – occurs on genitalia, perianal, mouth & throat; incubation = 3 weeks
  • Secondary – multi-system; rash, fever, malaise, headaches; incubation = 2-12 weeks
  • Latent – multi-system (dormant); asymptomatic; early < 1 year, late = 1 year or more
  • Tertiary – CV = 10-30 years; neurosyphilis (CNS, eyes) = < 2 years – 20 years; gumma (tissue destruction of any organ) = 1-46 years (most cases 15 years)
  • Important for management of cases and contacts
37
Q

Special considerations for pregnant women w/ syphilis

A
  • Screen for STIs at first prenatal visit, preferably 1st trimester
  • For high-risk women, screen at 28-32 weeks and again at delivery
38
Q

Special considerations for newborns w/ syphilis

A
  • Fetal risk highest when mom primary/secondary syphilis

- Screen newborn if signs or sx of early congenital syphilis

39
Q

Diagnosis of syphilis

A
  • History & clinical presentation

- Lab (difficult to grow) = dark field microscopy, NAAT, serologic

40
Q

Tx for syphilis in non-pregnant adults. What is the difference between a pt in primary, secondary, or early latent (< 1 year) and a pt in late latent, unknown latent, or other tertiary not involving NS?

A
  • Benzathine penicillin G 2.4 MU IM
  • Primary, secondary, or early latent = 1 dose
  • Late latent, unknown latent, or tertiary = weekly x 3 doses
41
Q

Cause of trichomoniasis

A
  • Trichomonas vaginalis

- Humans are only host & can only be spread through sexual contact (non-venereal infection uncommon/rare)

42
Q

Sx of trichomoniasis

A
  • Male = asymptomatic, urethral discharge, dysuria

- Female = asymptomatic, malodorous vaginal discharge & pruritus (worse during menses), dysuria

43
Q

Tx for trichomoniasis. How can efficacy be increased?

A
  • Metronidazole 2 g PO x 1 dose OR 500 mg PO BID x 7 days

- Efficacy increases if partner also treated

44
Q

Special consideration for trichomoniasis in pregnancy

A
  • May be associated w/ premature rupture of membrane, preterm birth, & low birth weight
  • Metronidazole not CI in pregnancy or breastfeeding

Year 3 - Clinical (30 decks)

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